Antidepressant use for mental health treatment of cancer patients; is it optimised?

Background The use of Psychotropic drugs, more specifically antidepressants (ADs) has been part of therapeutic management of cancer associated psychological burden.Aims/Hypothesis to be addressed To evaluate the effectiveness and safety of antidepressants (ADs) in cancer patients, identify gaps in existing guidelines, and propose development of comprehensive guidelines for their use and discontinuation.Design and methods A comprehensive search of PubMed, EBSCOhost, CINAHL, and the Cochrane Library was conducted from 2015 to 2024 to identify studies on the use of antidepressants in cancer patients, with a focus on GI cancers. Hand searching of reference lists from relevant reviews was also performed. We selected systematic reviews that used Prisma criteria, including a clear PICO plan. Only peer-reviewed studies in English were included, while qualitative research, conference proceedings, and editorials were excluded.Results First, depression is highly prevalent among cancer patients, with a substantial number experiencing extensive psychological distress that necessitates effective intervention including pharmacological and non-pharmacological. Second, evidence, from the available research, indicates that ADs are effective for controlling severe major depression in cancer patients. Third, the use of ADs specifically Selective Serotonin Reuptake Inhibitors (SSRIs) should be used with caution as they can interact with chemotherapeutic agents. Fourth, the withdrawal side effects of these agents may further disturb the ‘recovery’ of those who are deemed in remission or are cancer survivors. Fifth, there are national guidelines for ADs use in cancer patients but advice on their discontinuation is not routinely addressed.Conclusion The study of safe and efficient use of ADs among patients with cancer is attracting researchers and more studies are conducted to measure the safety and efficacy of this drug class among this population. However, clear guidelines are needed to identify which ADs have least potential drug interactions, as well as when ADs should be initiated and discontinued.